Sorry I may have wrong word. Basically going to work is ok, coming home is ok. If I have to go to a shop or somewhere other than work I feel like I want to hide, I will do all I can to avoid that trip. As though if I do it I'd rather have all the car windows blacked out so I can't be seen, the idea of walking down the high street terrifies me. I shake all over if I know I have to go anywhere where I may not be in control of I may see or bump into

First let me say that I can imagine how overwhelming and frustrating this situation must be for you. It seems like you may have been having these symptoms of anxiety and social phobia for a long time and I'm concerned that you haven't had proper treatment. I don't know what type of psychotherapy options are available on the Isle of Man. YOu need to have psychotherapy that is specific to social phobia, because Cognitive Behavioral Therapy has been show to be more effective for social phobia than medications. And it's a shame that you haven't had this opportunity till now to explore this treatment.

This is really what you need to be referred to: XXXXX XXXXX or psychotherapist who is familiar with anxiety and phobic disorders. It's very important that the therapist be experienced with phobias and social phobia (one of the most common) and practices CBT therapy.

I'll give you some techniques you can work on at home to help with the social phobia and to get you started. I'll also at the end of the answer give you a behavioral technique to get started with this. You can use this technique throughout the day when you are having anxiety. It is not a cure; it is something you can use to help yourself.

Let's work on five ways you can begin to build a behavioral program for yourself: diet, exercise, spiritual life, motivational reading and psychotherapy. The first four are to help you feel more involved and in control of yourself and what's going on inside. The psychotherapy is the main treatment and can actually teach you skills and give you tools for managing your symptoms.

Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. See what I mean about getting involved in controlling what's happening? With diet changes you are treating your problem with respect: you are acknowledging you need to make changes to get your body feeling better.

Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 800 to 3,000 mg daily. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality.

Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit. You are a young person so you may want to make the program more intensive.

Spiritual life: the medical literature is now rather overwhelming about the benefits to so many different areas of physical health of regular religious and spiritual practice. Going to church, meditation, etc. are all shown to produce benefits to the physical body. What about our mental health? Well, you will see that meditation is now a regular part of psychotherapy interventions. I don't know if you're a religious person or not. But if not, this may be a good time in your life to tune up your spiritual life. If you do not believe in G-d, that's not a barrier to your own spiritual life. Just thinking about the meaning of your life, of life in general, and studying spiritual texts and practices will help with the social phobia.

Then along with exploring the spiritual part of life, I want you to get really into motivational videos and books. Here's a simple YouTube search I put together for you on "motivational speakers":

Some like Tony Robbins are the classic big guys. Some are newer. Watch them all. Get inspired. Buy a book or two. Here are some possibilities, but they are only suggestions as there are so many good ones.

The first book is the father of all these type of books. How to Win Friends and Influence People by Dale Carnegie. There are classes in these books now! It was written in the 1930s and still has something to say to us today that is very worthwhile.

I think very highly of the second book on my list, which is a real classic: The Seven Habits of Highly Effective People by Stephen Covey. It is the book that has helped more people than probably any other.

The third book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.

Your doctor may refer you to a psychiatrist. But you need to know: a psychiatrist focuses on medications. And medications for phobias do not address the actual phobia. It only addresses the anxiety that comes from the phobia. But the ability to manage the social phobia is what you have to work on and meds won't address that.

So let's work on the type of therapy you need to undertake to get this phobia under control and managed. That's first. Second, we're going to use the technique I'm giving you at the end of my answer called Progressive Muscle Relaxation. Let's get started:

I want you to picture yourself and other people in a social situation (SS). This can be going to the store or something as intense as a party. As soon as the anxiety rises, as you're picturing the SS I want you to start practicing the PMR, okay? It needs to be really familiar to you.

So at first I want you to slowly imagine yourself going to an SS. Start at home in your imagination getting ready to go, then imagine going out the door, imagine getting into the car, driving or riding, getting out of the car, going in the door. Get the idea? Step by step.

And with each step, you pay close attention to what you're feeling. And when you feel anxiety, you do your PMR. And you tell yourself your feel good statement: It will soon be over and I can go have a treat. (Whether that treat is relaxing on the couch, an iced coffee, lunch out, whatever.) You can make your own feel good statement. It just has to be something that makes you feel a little brighter.

Then you continue with the imagining of the steps. You keep going until you've imagined all the way to leaving the SS. This may take a few times or a lot of times before you can imagine all the different steps without having overwhelming anxiety. But keep working at it. This is phobia work.

If there's a party or function or event coming up that you can use for this, even better. Or best, XXXXX XXXXX for going to the store. Because as you can imagine: the next step will be to not just imagine the SS but to actually go. And to do your PMR in the car, etc. as you are actually having the experience. And then eventually, you will become less and less anxious as you gain experience with this.

This is what you will most likely be doing with a psychotherapist to help with this. The preferred form of treatment today is Cognitive Behavioral Therapy to learn skills like I've been teaching you. Here is the American Amazon web page address for the classic workbook for phobias by Edmund Bourne:

So you need to ask for a referral from your doctor or friends for a psychologist or licensed psychotherapist. Of if you need to go to the mainland, then do that.

Okay, that should help you get working on these symptoms and get some relief.

I wish you the very best!

Now, I want to give you a tool to use for when the anxiety is present for you. It is quite easy to do almost anywhere. My patients suffering from anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?

Please remember to click the green accept button because: even though you have made a deposit, I do not get paid for my time unless you press ACCEPT. You are not charged anything more than the deposit you already made by pressing ACCEPT. Feel free to continue the discussion even after pressing ACCEPT as my goal is to get you the best answer possible. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

INSTRUCTIONS:

After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.

Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.

Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.

Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.

Continue down your body, repeating the procedure with the following muscle groups:

chest

abdomen

entire right arm

right forearm and hand (making a fist)

right hand

entire left arm

left forearm and hand (again, making a fist)

left hand

buttocks

entire right leg

lower right leg and foot

right foot

entire left leg

lower left leg and foot

left foot

for the shortened version, which includes just four main muscle groups:

face

neck, shoulders and arms

abdomen and chest

buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

A comfortable place.

Some privacy.

A few minutes.

Again:

Please remember to click the green accept button because: even though you have made a deposit, I do not get paid for my time unless you press ACCEPT. You are not charged anything more than the deposit you already made by pressing ACCEPT. Feel free to continue the discussion even after pressing ACCEPT as my goal is to get you the best answer possible. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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